Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari

Carbapenem-resistant Enterobacterales (CRE) require early identification and appropriate patient placement to prevent in-hospital transmission. Bed Management plays a key organizational role in coordinating screening results and isolation strategies; however, evidence on its impact on patient flow and isolation practices remains limited. To evaluate whether the implementation of a Bed Management-coordinated structured CRE screening pathway was associated with changes in patient placement appropriateness and time to admission (TTA). We conducted a retrospective cohort study including all patients with a positive rectal swab for CRE during two study periods (PRE: 2024; POST: 2025) in a tertiary care hospital. A structured CRE screening pathway coordinated by Bed Management was implemented in the POST period. Primary outcomes were cohort isolation rates and TTA. Continuous variables were compared using the Mann-Whitney U test and categorical variables using the chi-square test. A total of 158 CRE-positive patients were included (69 in the PRE period and 89 in the POST period). Patient characteristics were comparable between periods (median age 75 years [IQR 64-81] vs. 73 years [IQR 64-82]; female sex 33.3% vs. 44.9%, p = 0.189). Cohort isolation rates were higher in the POST period. Median time to admission (TTA) decreased from 74.8 h (IQR 47.2-124.6) in PRE to 70.7 h (IQR 35.1-139.9) in POST; however, this difference did not reach statistical significance (Mann-Whitney U test, p = 0.630). A Bed Management-coordinated CRE screening pathway was associated with improved cohort isolation practices and an observed, non-significant reduction in TTA. These findings suggest that integrating infection prevention workflows with centralized bed allocation may be feasible without adversely affecting admission timeliness. Further studies with larger samples and longer observation periods are warranted.

Introduction. Monoclonal gammopathies of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) have been often reported coexistent to several autoimmune conditions in previous retrospective studies. Interestingly, in a recent cross-sectional, prospective, population-based screening study (Sverrisdottir I. et al. Ann Intern Med. 2024) of Icelandic persons aged 40 years or older, a diagnosis of an autoimmune disease was not associated with MGUS, although it was significantly more present in individuals with a prior clinical diagnosis of MGUS. Specific immunosuppressive therapies and “biologic” agents, including monoclonal antibodies, are frequently required in patients with autoimmune disorders. In this setting, however, limited data are available concerning whether these drugs may favour an increase of monoclonal protein (M-protein) or even the progression of these conditions to overt multiple myeloma (MM). On the other hand, in the clinical practice, hematologists are frequently asked to answer to this question. Methods. On this basis, we retrospectively evaluated the trend of M-protein in 37 patients with monoclonal gammopathy (34 MGUS; 3 SMM) followed at our institution and, at the same time, under treatment for autoimmune disorders (inflammatory bowel disease, rheumatologic, neurologic, cardiac/pneumological diseases). The protein change was calculated as the difference between the last and first M-protein values. Only patients with measurable M-protein and non-IgM isotype were included in the analysis; their clinical characteristics are summarized in Table 1. Results. The median age was 67 years (range 34-84), with a female predominance (67.6%). Regarding concomitant autoimmune diseases, 29 patients (78.4%) were affected by rheumatologic disorders, 4 (10.8%) by inflammatory bowel diseases, 2 (5.4%) by neurologic diseases and 2 (5.4%) by cardiac/pneumological disorders. Regarding M-protein, IgG kappa was the most frequent isotype (70.3%) reported. Specific treatments for these disorders included immunosuppressive drugs and biological agents, sometimes associated (Table 1). With a median time of observation of 48 months (range: 9-236), no significant difference (p-value = 0.4682, Kruskal–Wallis) was reported in M-protein concentration during follow-up and no patient developed clinical symptoms of active MM. Likewise, no decrease in M-component was observed, independently upon the efficacy of the treatments applied for the autoimmune disorders. Conclusions. Our still preliminary data suggests no evident relationship between MGUS/SMM evolution and underlying autoimmune disorders receiving immunosuppressive treatments. These data are certainly reassuring, as they would not support a link between plasma cell dyscrasia progression and treatments necessary for contemporary autoimmune diseases. Studies on a larger number of patients with extended follow-up are ongoing to achieve greater generalizability of our preliminary findings.

Introduction. Nowadays continuous treatment until disease progression or unacceptable toxicity remains the main approach in multiple myeloma (MM). However, prolonged exposure may lead to cumulative toxicity, treatment fatigue and quality-of-life impairment. In clinical practice, a not negligible number of patients discontinues therapy due to medical, personal, or logistic reasons. Recent evidence from time-limited regimens has renewed interest in whether discontinuation may be feasible and safe in selected cases. Methods. The on-going ODISSEY study (A multicenter, Observational stuDY of multiple myeloma patientS who diScontinuEd therapY in clinical practice) was designed to describe clinical features and outcome of MM patients who discontinued treatment for reasons other than disease progression or death and were alive in remission for at least 12 months, aiming to identify predictors of prolonged treatment-free remission (TFR). Results. Fifty-one patients diagnosed between 2007 and 2022 have been so far enrolled. The median age at discontinuation was 73 years (range, 52-88). At diagnosis, eighteen patients (35.3 %) were in ISS stage I; seventeen (33.3%), in stage II; sixteen (31.4%), in stage III. Treatment was discontinued during first, second and third or subsequent lines in 25 (49.1%), 22 (43.1%) and 4 (7.8%) patients, respectively. Specifically, discontinuation in first line mainly occurred during lenalidomide/thalidomide maintenance (52%) and in second line mainly under daratumumab/carfilzomib-lenalidomide-dexamethasone combinations (63.6%). The median duration of treatment leading to discontinuation was 23 months (range, 2–87), overlapping the median treatment duration from best-response achievement to discontinuation. At suspension of therapy, most of patients (80.4%) were in complete response (34 CR; 7 sCR). Main reasons for discontinuation were non-hematologic toxicity (25.6%), shared medical decision (19.6%), hematologic toxicity (15.7%), patient’s choice (11.7%), newly acquired comorbidities (11.7%), or other causes (15.7%). Median TFR was 46 months (95%CI 41–NR) (Figure 1). At a median follow-up of 26 months (range, 9-130) from treatment discontinuation, 44 (86.3%) patients were alive and most of them (84.1%) were still in remission. Conclusions. The ODISSEY study represents one of the first real-world experiences exploring treatment discontinuation in MM outside of clinical trials. Despite heterogeneous therapeutic settings, a subset of patients achieved durable off-therapy remissions, supporting the feasibility of treatment cessation in selected cases. Future studies incorporating measurable residual disease assessment could validate these preliminary findings. In a broader perspective, ODISSEY contributes to the concept of sustainable MM care, integrating efficacy, safety, quality of life, and optimization of healthcare resources, with reduced drug exposure, lower treatment-related costs, and fewer hospital visits.

B-cell receptor inhibitors (BCRi) and B-cell lymphoma-2 inhibitor (BCL2i) improved outcomes of patients with chronic lymphocytic leukemia (CLL), but relapsing after two inhibitors still represent an unmet clinical need. This multicenter real-world study analyzes outcomes of a cohort treated in Italy between May 2017 and September 2023 following prior exposure to both BCRi and BCL2i. The median follow-up after venetoclax initiation was 47months (IQR 28-56). Of 153 double-exposed patients, 104 (68%) discontinued venetoclax and 53 of them (51%) received a subsequent treatment. Venetoclax was discontinued due to progressive disease (PD) in 51/104 cases (49.0%), with nine deaths occurring rapidly after PD without the administration of any further treatment. Fifty-three patients received treatment after venetoclax: 29/53 (54.7%) received inhibitors (13 cBTKi, 11 idelalisib, 2 BCL2i, 3 non-covalent BTKi), 19/53 (35.8%) received chemoimmunotherapy (CT: 16 intensive, 3 palliative), 5/53 (9.4%) received hematopoietic stem cell transplantation (HSCT). Overall response rate was 50%; median event free survival (EFS) in the groups of inhibitors, CT and HSCT was 11, 2, and 10months, respectively (p<0.0001); median overall survival (OS) was 12, 5, and 10months, respectively (p=0.020). Disease progression during venetoclax treatment was associated with shorter subsequent EFS compared to discontinuation for other reasons, even if the finding did not reach statistical significance (median EFS 4 vs. 10months; p=0.11). No decrease in EFS was associated with del17p and/or TP53 mutations, the use of venetoclax monotherapy or a previous treatment with one versus multiple BCRi. Despite its limitations, this real-world study provides additional insights into double-exposed patients, who still pose a clinical challenge, demonstrating the superior efficacy of inhibitors over alternative treatment options. Enrollment in clinical trial and treatments with novel molecules, if available, may help address this unmet clinical need.

Not available.

The use of fibrobronchoscopy increased significantly for collecting airway microbiological samples and during percutaneous tracheostomies and difficult intubations. Reusable bronchoscopes pose risks of contamination and damage due to their fragile structure and difficulties of cleaning and sterilization; single-use bronchoscopes have been introduced, offering reliability in terms of vision, maneuverability, suctioning capacity, and sterility, reducing the risk of hospital-acquired infections and improving logistical management. The study analyzed healthcare workers' and management's perceptions of single-use bronchoscopes versus reusable ones. Among the main objectives were to evaluate the organizational impact, quality, and performance of bronchoscopes, while also analyzing opinions on device features, safety in infection prevention, and ease of use during training. In this analysis 66% of clinicians rated optimal image quality, and 90% of respondents highly appreciated the "plug & play" feature of disposable endoscopes; also, 45% of clinicians noted no significant differences in aspiration performance. Healthcare professionals felt more exposed to infectious agents with reusable endoscopes, believing disposable endoscopes required less vigilance and monitoring. In training, 80% of doctors and 100% of nurses considered disposable endoscopes more suitable due to their greater ease of use. Finally, the Overall Satisfaction of all healthcare workers was 75%. The analysis of results demonstrated that the use of single-use bronchoscopes in anesthesia and resuscitation is highly comparable in terms of clinical effectiveness to reusable ones and that significant advantages in costs and organizational impact were highlighted, positively impacting the daily workflow of healthcare workers.

Abstract Background Janus kinase inhibitors (JAKi) are a class of oral therapies indicated for moderate-to-severe ulcerative colitis (UC), with three agents approved and broadly comparable efficacy and safety. Although no clear evidence shows that differences in target affinity influence response, switching to a second JAKi is sometimes attempted after failure or intolerance to the first. The main objective is to assess the effectiveness (defined as treatment persistence) and safety of a second JAKi after failure of the first one Methods This retrospective analysis is part of a 12-month, multicentre, ambispective observational study. We included patients who initiated a second JAKi less than 24 months prior to enrolment, following a first-line JAKi course. Demographics, disease features, and clinical, biochemical, and endoscopic data at baseline and at weeks 8, 26, and 52 were recorded in a REDCap database. Data are presented as frequencies and percentages. Treatment persistence was estimated with Kaplan–Meier survival analysis, and rates are reported both as observed and with non-responder imputation (NRI). Safety events were collected throughout follow-up. Recruitment for both retrospective and prospective phases is ongoing and will end in April 2026; this abstract presents preliminary. Results Data from 69 UC patients are currently available: median age 40 years (IQR 27–52); 30 (43.5%) females. Mean disease duration was 10.8±7.9 years. Disease extent: proctitis 3 (4.3%), left-sided colitis 29 (42.0%), extensive colitis 37 (53.7%). Eight patients (11.6%) were smokers, and 11.6% had other cardiovascular risk factors. Most patients (40, 57.9%) had prior exposure to ≥ 3 biologics or small molecules. Tofacitinib was the most common first JAKi (48, 69.6%) prescribed; among those who switched from tofacitinib, 9 (24.3%) moved to filgotinib and 28 (75.7%) to upadacitinib. Reasons for discontinuing the first JAKi were secondary loss of response in 42 patients (62%), primary non-response in 24 (34%), and intolerance in 3 patients (4%). At baseline, the mean Partial Mayo score was 5.1±2.3, and 20 (29%) were on systemic steroids. At week 26, treatment persistence was 87.0% (47/54) as observed and 68.1% (47/69) with NRI; at week 52 it was 85.1% (40/47) as observed and 58.0% (40/69) with NRI. Six patients experienced adverse drug reactions, none leading to discontinuation Conclusion Our preliminary findings suggest that switching from a first to a subsequent JAKi is effective and safe, including for patients with prior exposure to multiple biologic therapies. Further retrospective and prospective analyses will provide more precise estimates